Printable Doctor Visit Notes: Free Appointment Checklist and Log (PDF)

All four files have the same seven pages. Pick the paper size you use: US Letter in the US and Canada, A4 almost everywhere else.

• Doctor Visit Notes, color, US Letter (PDF, 7 pages)
• Doctor Visit Notes, black and white, US Letter (PDF, 7 pages)
• Doctor Visit Notes, color, A4 (PDF, 7 pages)
• Doctor Visit Notes, black and white, A4 (PDF, 7 pages)

Fill in the health summary and medicine list once and keep them up to date. Print a fresh visit notes page for each appointment.

• Page 1 — Cover.
• Page 2 — Getting ready for a visit: a tick list for before, during and after the appointment.
• Page 3 — My health summary: contact and insurance details, conditions, past surgeries and hospital stays, allergies, and your doctors and pharmacy.
• Page 4 — My medicines: everything you take, with the dose, when, what it is for and who prescribed it.
• Pages 5 and 6 — Visit notes: one page per appointment, from your questions to what you do next.
• Page 7 — Appointment log: every visit on one line, so you can see the whole year at a glance.

The Agency for Healthcare Research and Quality suggests the first three of these before the visit; the fourth helps many families too:

1. 1

   Bring all your medicines

   prescriptions, non-prescription medicines such as aspirin or antacids, vitamins and supplements, or bring the medicine list from page 4.

2. 2

   Write down your questions

   and put the most important ones first, in case time runs short.

3. 3

   Know your medical history

   your current conditions, past surgeries and illnesses. The health summary on page 3 holds them.

4. 4

   Bring someone along if it helps

   to listen, take notes and remember what was said.

AHRQ’s tips for during the visit come down to making sure you understand before you leave:

• Explain your symptoms, your health history and any problems you have had with medicines.
• Ask questions until you understand what the doctor is telling you, and say if you are worried about following the instructions.
• If a treatment is recommended, ask about the options.
• If you need a test, ask how it is done, how it will feel, how to get ready and how you will get the results.
• Ask for written instructions before you leave.

And after the visit:

• Follow the instructions, and call the office if anything is unclear once you are home.
• Talk with your doctor or pharmacist before you stop any medicine your doctor prescribed.
• Call if your symptoms get worse, or if you have trouble following the instructions.
• Book any tests or specialist visits, and call for test results if you have not heard.

• Agree beforehand on the top three questions, and who will ask them.
• Let your parent speak first, then fill in what they leave out.
• Write down what the doctor says on the visit notes page, especially medicine changes and when to call.
• Keep the medicine list current after every visit, and bring it to the pharmacy too.